Provider Demographics
NPI:1730615360
Name:POTER, MATTHEW BRITTON (RD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRITTON
Last Name:POTER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11430 EAST FWY STE 330
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-1959
Mailing Address - Country:US
Mailing Address - Phone:713-446-3723
Mailing Address - Fax:
Practice Address - Street 1:11430 EAST FWY STE 330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1959
Practice Address - Country:US
Practice Address - Phone:713-446-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81361133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered